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A Michigan woman has died 61 days after receiving a pair of lungs from an organ donor who had been infected with the coronavirus, according to a case report released this month.
There was no indication that the donor, a woman fatally injured in a car accident, was a carrier of Covid-19. An x-ray of his chest had appeared clear and a nasal swab test for the coronavirus had returned a negative result.
But doctors who worked with the lung recipient at University Hospital in Ann Arbor, Mich., Last fall began to question those findings when their patient’s condition worsened. They concluded that the donor did indeed have Covid-19 – and that her lungs had infected not only the transplant patient, but the surgeon as well.
This was the first confirmed case of a patient contracting the virus from the patient’s organ donor, according to the authors of the peer-reviewed report, which appeared in The American Journal of Transplantation on February 10.
“We want the transplant community to know that this can happen, and also that maybe we can do things to improve our success in screening patients for Covid,” said surgeon, Dr Jules Lin, author of report and the surgical director of the lung transplant program at Michigan Medicine, the University of Michigan Health System.
The report says healthcare professionals should consider testing lung donors for coronavirus using a sample from their lower airways, which extends into the lungs – beyond the reach of a nasal swab. This type of test, which is invasive and not recommended for the general public, is not always available; currently only about a third of donated lungs are tested this way.
Dr David Klassen, chief medical officer of the United Network for Organ Sharing, the nonprofit that manages the nation’s organ transplant system, said the Michigan case was “very important” despite its rarity.
“We want to minimize the chances of this happening again,” he said.
Every organ donor in the United States is tested for the coronavirus in one way or another, said Dr Klassen. The tests are not performed by transplant surgeons; instead, they’re usually overseen by nonprofit groups known as organ procurement organizations, which operate across the United States.
The Association of Organ Procurement Organizations referred questions to Gift of Life Michigan, which was not involved in the matter. Its clinical director, Bruce Nicely, said many labs refused to take samples from the lower lungs at the start of the pandemic, fearing the procedure would help spread the coronavirus.
“In response to the study’s recommendations, we are all in favor of recommendations that improve safety and reduce the risk of infection,” Nicely said, adding that his organization has found a partner laboratory capable of performing tests on the lower respiratory tract. leaflet.
When organs become available, time is running out. Some healthcare facilities do not have the resources to quickly test donors’ lower respiratory tract for Covid-19. Given these constraints, it is not necessary for lung donors to be tested in this manner.
“We could mandate him,” said Dr Klassen. “But that could have the downstream effect of drastically limiting the lungs that could be used for transplantation.”
Of the nearly 40,000 organ transplants performed in the United States last year, the operation in Michigan was the only confirmed case of a recipient contracting the coronavirus from a donor.
“It’s important to stress that this is, thankfully, a rare event,” said Dr. Daniel R. Kaul, study author and infectious disease specialist at Michigan Medicine. The case, he said, shouldn’t deter people from getting transplants that could save their lives.
He added that the organ recipient, who suffered from chronic obstructive pulmonary disease, appeared to have undergone successful surgery until his condition worsened a few days later.
“All of a sudden she had a fever, low blood pressure, pneumonia,” Dr Kaul said. “I wasn’t sure what was going on.
When further testing showed the woman had Covid-19, doctors turned to the lung donor. Her nasal swab test came back negative before the transplant, but these tests don’t capture everything. Doctors had to find a way to retest the donor.
In fact, they had exactly what they needed: a specimen of the deceased woman’s lower respiratory tract. Michigan Medicine regularly collects such samples from lung donors for testing – not for Covid-19, but for ureaplasma, a bacteria that can cause a rare syndrome.
Doctors found that they still had enough of the donor’s sample to test for the coronavirus. The result showed that the donor had indeed been infected with the virus, and gene sequence analysis showed that the patient had contracted the virus from the lungs of the donor.
Just like Dr. Lin, who wore a surgical mask during the transplant operation. (The report he co-wrote recommends that transplant centers consider the benefits of wearing N95 masks throughout the hour-long procedure, even if the donor has tested negative for the coronavirus.) He has spent a few weeks recovering from the infection at home, he said, adding that the infection had not spread to his colleagues or family members.
The patient, vulnerable following a major operation, has not recovered despite attempts by doctors to save her with a series of treatments including convalescent plasma, steroids and remdesivir. Doctors are now hoping his case report will persuade more medical professionals to step up their coronavirus testing standards for organ donors, despite logistical difficulties.
“I think these are hurdles that we need to work on to overcome,” said Dr. Lin, “for the safety of our patients.”
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